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Maintaining or building lean muscle mass supports metabolic rate and counteracts the natural decline in muscle that occurs when estrogen drops

- **Clinical outcomes**: Progress notes should track changes in exercise capacity, symptoms, and hemoglobin levels to justify continued or repeat courses

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Overall body weight and BMI did not change significantly, but small improvements were noticed in men

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advanced endometriosis is associated with adhesions and altered pelvic anatomy that can impair the movement of oocytes and sperm, induce uterine dysfunction, and prevent normal fertilization and embryonic development